Endometriosis: Symptoms, Diagnosis, and Treatment

Endometriosis is a chronic gynecologic condition, in which the tissue that forms the inner lining of the uterus, grows outside of the uterus. It is a chronic condition that affects approximately 10% of menstruating women worldwide. In this blog post, we will take a closer look at the symptoms, diagnosis and treatment options of endometriosis.
Sabrina Greco

Sabrina Greco

MSc in Anatomical Sciences at Queen’s University in Canada

A blue image with text saying "Endometriosis"

What is endometriosis?

Endometriosis is a chronic gynecologic condition, in which the tissue that forms the inner lining of the uterus, grows outside of the uterus. The tissue can be referred to as endometrial growths, implants, or lesions. It is a chronic condition that affects approximately 10% of menstruating women worldwide. [1]

Endometriosis and the uterus

Endometriosis is a condition that affects the uterus, ovaries, and other organs of the pelvis. The uterus is an organ of the female reproductive system. The tissue which forms the inner lining of the uterus is called the endometrium, and it is sensitive to natural monthly hormone fluctuations.

Endometriosis is an estrogen-dependent condition, meaning the condition is influenced by the hormone estrogen. Estrogen stimulates the growth of the endometrium. During the menstrual cycle, if fertilization does not occur, levels of estrogen decline, and the endometrium is shed. The natural hormonal fluctuations of the menstrual cycle will affect all endometrial tissue, including endometrial implants. This means for individuals with endometriosis, the endometrial implants will grow, develop, and break down in response to menstruation [2].

Causes of endometriosis

The exact cause of endometriosis is not fully understood, but several factors may contribute to its development [3, 4].

These factors include:

  • Retrograde menstruation
  • Transformed peritoneal cells
  • Surgical scar complications
  • Genetic predisposition
  • Immune system abnormalities

What happens as endometriosis develops?

Endometriosis is a progressive condition that develops as endometrial implants form on organs and tissues outside of the uterus. Other organs and tissues of the pelvis are most impacted; however, it is possible for the growths to be found in regions beyond the pelvis. Common areas of endometrial implant locations include, the ovaries (66.94%), utero-sacral ligaments (45.51%), and the bladder (21.25%) [5]. The implants can also be found on tissue lining the abdomen and pelvis (peritoneal endometriosis).

Endometrial implants develop and are broken-down in response to natural hormone fluctuations. The tissue that is broken-down remains in the pelvis, which can lead surrounding tissues to become irritated, inflamed, and swollen. Over time, this process can also cause scar tissue to form. Adhesions can form from excess scar tissue, which can cause organ and tissue surfaces to stick together. This process often creates symptoms of pelvic discomfort and pain.

Symptoms of Endometriosis

The symptoms of endometriosis vary and can range from mild to severe. Each experience is different. The most common symptom of endometriosis is pelvic pain. Often, symptoms are most severe just before and during menstruation.

Common symptoms of endometriosis

Common symptoms of endometriosis can include:

Pain [6, 7]

  • Pelvic pain. The most common symptom of endometriosis.
  • Severe menstrual cramps (dysmenorrhea).
  • Lower back pain.
  • Pain during or following sexual intercourse (dyspareunia). Endometriosis can contribute to sexual dysfunction. Chronic pain associated with endometriosis can also lead to a decrease in sexual desire or libido.
  • Rectal pain.
  • Pain with urination or bowel movements.

Bleeding

  • Heavy menstrual bleeding.
  • Bleeding between menstrual periods.
  • Vaginal bleeding following sexual intercourse.
  • Blood in the urine or stool.

Difficulty getting pregnant (infertility)

  • Endometriosis affects up to 50% of women who experience infertility [8]. In some cases, endometriosis is first identified during tests for infertility treatment.
  • Endometriomas are a type of ovarian cyst that can develop in more severe stages of endometriosis. The cysts negatively impact fertility. Severe and sudden abdominal and pelvic pain may be experienced if an endometrioma ruptures [9].

Abdominal bloating

  • Bloating and fluid retention are common in endometriosis.

Chronic fatigue

  • Fatigue can impact daily activities and quality of life, causing major distress.
  • Fatigue in endometriosis has also been found to be associated with insomnia and occupational stress [10].

Mental health

  • Endometriosis can highly impact mental health and quality of life.
  • Endometriosis is associated with a high prevalence of depression and anxiety symptoms, with impacts on psychological health and well-being [11].

Uncommon symptoms of endometriosis

Although pelvic endometriosis is most common, the condition can affect organs and tissues beyond the pelvis. Symptoms will manifest based on the location of developing endometrial implants.

Endometriosis can occur in regions of the body distant to the pelvis, such as the thorax. Symptoms of thoracic endometriosis can include shortness of breath (dyspnea), chest pain and coughing up blood (hemoptysis) [12].

Find out more about uncommon symptoms of endometriosis Uncommon symptoms of endometriosis.

Symptoms of endometriosis vary. Not all individuals with endometriosis experience all of these symptoms, and some may have the condition without experiencing any symptoms.

It’s important to get regular gynecological exams, which will allow your healthcare provider to monitor any symptoms or changes.

Diagnosis

Endometriosis is most often diagnosed in women in their 30s and 40s. Endometriosis can present symptoms similar to other conditions, prolonging diagnosis. Studies have found a well-established delay of 4-11 years from first symptom onset to surgical diagnosis [13].

How is endometriosis diagnosed?

History and physical exam

Your healthcare provider will first take a personal history and note your symptoms.

Next, your healthcare provider will perform a pelvic exam. During a pelvic exam, the healthcare provider will use a speculum and light to visualize the inside of the vagina and cervix. They will also examine and feel your abdomen for cysts and scar tissue behind the uterus.

Imaging tests

Your healthcare provider may next suggest imaging to identify cysts, scar tissue and adhesions in the pelvis. Ultrasound imaging is commonly used. Your healthcare provider may use an abdominal or transvaginal ultrasound. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are other imaging tests that can be used.

These imaging tests will provide your healthcare provider with a detailed image, aiding in the detection of any abnormal growths associated with endometriosis.

Surgery

Endometriosis can only be definitively diagnosed through a surgical procedure to confirm the presence of endometrial implants or growths.

A laparoscopy is a minimally invasive surgical procedure that is commonly used in the diagnosis of endometriosis. A laparoscopy involves inserting a small tube with a camera through an incision made in the abdomen. Your healthcare provider may also suggest a biopsy at this time, where a tissue sample is removed during the procedure, and sent to be tested in a lab, to confirm diagnosis [14].

Treatment

There are treatments currently available to effectively manage endometriosis. Endometriosis is a chronic condition. There currently is no cure, but symptoms can be managed.

Each experience is different. Speak to your healthcare provider to find the treatment option that is best for you.

Medication

Pain medication

Pain medications, including non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, work to reduce inflammation and pain. Speak to your healthcare provider about over-the-counter or prescribed medications to help manage pain.

Hormone therapy

Hormone therapies, including oral contraceptives and gonadotropin-releasing hormone (GnRH) agonists, work to alleviate pain and slow the progression of endometriosis. Supplemental hormone therapy works to help the body regulate estrogen to slow the growth of endometrial implants and subsequently reduce symptoms [15, 16].

Hormone therapies include:

Hormonal birth control

  • Oral contraceptives are commonly suggested. Contraceptives can regulate the menstrual cycle and reduce the growth of endometrial implants.
  • Hormonal patches and vaginal rings are other options.

Gonadotropin-releasing hormone (GnRH) agonists

  • Leuprolide is a common GnRH agonist. These work to suppress the production of estrogen, to reduce symptoms and the growth of endometrial implants.

Progestin-only contraceptives

  • Medroxyprogesterone acetate is a progestin-contraceptive that works to inhibit ovulation and control endometrial implant growth.

Currently, new medications such as GnRH antagonists, aromatase inhibitors, and flexible extended combined oral contraceptives are under development [17].

Side effects can be expected with any medication. Speak to your healthcare provider before beginning any medications, to avoid potential drug interaction complications.

Surgery

Surgery is typically suggested in cases where hormone therapy and medications are not providing relief, or for more severe symptoms. Surgical treatment for endometriosis aims to identify and remove endometrial implants, restore anatomy, and relieve symptoms [18].

Laparoscopy for endometriosis

A laparoscopy is a minimally invasive surgical procedure, that can provide information about the location, extent and size of endometrial implants. During the surgery, your healthcare provider will insert a viewing instrument (laparoscope) and surgical tools through small incisions in the abdomen. The healthcare provider will then identify, locate, and remove abnormal growths, including endometrial implants, endometriomas and scar tissue. Hormone therapy is often restarted following surgery to prevent recurrent implant growth and manage symptoms.

Hysterectomy and oophorectomy for endometriosis

Hysterectomy and oophorectomy surgeries are suggested to ease symptoms when other treatments for endometriosis have not worked.

A hysterectomy is a surgery to remove the uterus. An oophorectomy is a surgery to remove the ovaries. The ovaries produce estrogen; therefore, oophorectomy for endometriosis aims to regulate hormones, prevent endometrial implant development and reduce symptoms.

These treatments are associated with a low reoperation rate and may improve quality of life. Surgical treatment should be carefully considered due to potential implications and long-term effects, such as surgical menopause following oophorectomy [19].

Surgical treatment for endometriosis aims to improve symptoms and prevent the recurrence of the condition. It is often used with hormone therapy or other treatments to optimize outcomes. Surgical treatments can improve the quality of life and fertility for those with endometriosis. Speak to your healthcare provider about treatment options that are best for you.

Surgical treatment for endometriosis aims to improve symptoms and prevent the recurrence of the condition. It is often used with hormone therapy or other treatments to optimize outcomes. Surgical treatments can improve quality of life and fertility for those with endometriosis. Speak to your healthcare provider about treatment options that are best for you.

What are my alternative options?

Complementary and alternative medicine (CAM) therapies can be used to support those with endometriosis [20]. This includes therapies such as acupuncture, chiropractic care, and naturopathic remedies and supplements. Speak to your healthcare provider for alternative suggestions or therapies.

Self-care or home treatments may also ease symptoms of endometriosis. Find out more about endometriosis self-care treatment options here.

Complementary and alternative medicine (CAM) therapies are often used to support those with endometriosis. This includes therapies such as acupuncture, chiropractic care, and naturopathic remedies and supplements. Ask you healthcare provider for alternative suggestions or therapies.

Self-care or home treatments may also ease symptoms of endometriosis. Find out more about endometriosis self-care treatment options Self-care strategies.

Conclusion

Endometriosis is a chronic and challenging condition, that has a profound influence on the wellbeing of many individuals. By understanding the symptoms and seeking timely care, you can work with your healthcare providers to develop a treatment plan that best fits your needs.

For more information about endometriosis, go to MediSearch.io. Always consult a healthcare professional regarding your condition.

Sabrina Greco

Sabrina Greco

Sabrina is a pre-medical student based in Toronto, Canada. She completed her BSc in Life Sciences and her MSc in Anatomical Sciences at Queen’s University in Canada. Her recent research focused on investigating the symptoms and experiences of women who have undergone gynecologic surgery. Her research has been published in the Journal of Obstetrics and Gynecology Canada, and presented at the International Society for the Study of Women’s Sexual Health Annual Conference 2022 and 2023. Sabrina is a patient advocate dedicated to improving communication and knowledge translation practices in clinical settings.